How to assess tissue oxygenation?

Backer, Daniel De; Ospina-Tascón, Gustavo Adolfo

doi:10.1097/mcc.0000000000001046

Cited by 5 publications

References 69 publications

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Intestinal oxygen utilisation and cellular adaptation during intestinal ischaemia–reperfusion injury

Archontakis‐Barakakis,

Mavridis,

Chlorogiannis

et al. 2024

Clinical & Translational Med

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The gastrointestinal tract can be deranged by ailments including sepsis, trauma and haemorrhage. Ischaemic injury provokes a common constellation of microscopic and macroscopic changes that, together with the paradoxical exacerbation of cellular dysfunction and death following restoration of blood flow, are collectively known as ischaemia–reperfusion injury (IRI). Although much of the gastrointestinal tract is normally hypoxemic, intestinal IRI results when there is inadequate oxygen availability due to poor supply (pathological hypoxia) or abnormal tissue oxygen use and metabolism (dysoxia). Intestinal oxygen uptake usually remains constant over a wide range of blood flows and pressures, with cellular function being substantively compromised when ischaemia leads to a >50% decline in intestinal oxygen consumption. Restoration of perfusion and oxygenation provokes additional injury, resulting in mucosal damage and disruption of intestinal barrier function. The primary cellular mechanism for sensing hypoxia and for activating a cascade of cellular responses to mitigate the injury is a family of heterodimer proteins called hypoxia‐inducible factors (HIFs). The HIF system is connected to numerous biochemical and immunologic pathways induced by IRI and the concentration of those proteins increases during hypoxia and dysoxia. Activation of the HIF system leads to augmented transcription of specific genes in various types of affected cells, but may also augment apoptotic and inflammatory processes, thus aggravating gut injury.Key points During intestinal ischaemia, mitochondrial oxygen uptake is reduced when cellular oxygen partial pressure decreases to below the threshold required to maintain normal oxidative metabolism. Upon reperfusion, intestinal hypoxia may persist because microcirculatory flow remains impaired and/or because available oxygen is consumed by enzymes, intestinal cells and neutrophils.

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Intestinal oxygen utilisation and cellular adaptation during intestinal ischaemia–reperfusion injury

Archontakis‐Barakakis,

Mavridis,

Chlorogiannis

et al. 2024

Clinical & Translational Med

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Cardiovascular System, Its Functions and Disorders

Rabadia,

Thite,

Desai

et al. 2024

Cardioprotective Plants

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Association between fluid overload and mortality in children with sepsis: a systematic review and meta-analysis

Fernández-Sarmiento,

Sierra-Zuñiga,

Salazar González

et al. 2023

bmjpo

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BackgroundSepsis is one of the main causes of morbidity and mortality worldwide. Fluid resuscitation is among the most common interventions and is associated with fluid overload (FO) in some patients. The objective of this systematic review and meta-analysis was to summarise the available evidence on the association between FO and morbimortality in children with sepsis.MethodsA systematic search was carried out in PubMed/Medline, Embase, Cochrane and Google Scholar up to December 2022 (PROSPERO 408148), including studies in children with sepsis which reported more than 10% FO 24 hours after admission to intensive care. The risk of bias was assessed using the Newcastle-Ottawa scale. Heterogeneity was assessed using I2, considering it absent if <25% and high if >75%. A sensitivity analysis was run to explore the impact of the methodological quality on the size of the effect. Mantel-Haenszel’s model of random effects was used for the analysis. The primary outcome was to determine the risk of mortality associated with FO and the secondary outcomes were the need for mechanical ventilation (MV), multiple organ dysfunction syndrome (MODS) and length of hospital stay associated with FO.ResultsA total of 9 studies (2312 patients) were included, all of which were observational. Children with FO had a higher mortality than patients without overload (46% vs 26%; OR 5.06; 95% CI 1.77 to 14.48; p<0.01). We found no association between %FO and the risk of MODS (OR: 0.97; 95% CI 0.13 to 7.12; p=0.98). Children with FO required MV more often (83% vs 47%; OR: 4.78; 95% CI 2.51 to 9.11; p<0.01) and had a longer hospital stay (8 days (RIQ 6.5–13.2) vs 7 days (RIQ 6.1–11.5); p<0.01).ConclusionIn children with sepsis, more than 10% FO 24 hours after intensive care admission is associated with higher mortality, the need for MV and length of hospital stay.

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How to assess tissue oxygenation?

Cited by 5 publications

References 69 publications

Intestinal oxygen utilisation and cellular adaptation during intestinal ischaemia–reperfusion injury

Intestinal oxygen utilisation and cellular adaptation during intestinal ischaemia–reperfusion injury

Cardiovascular System, Its Functions and Disorders

Association between fluid overload and mortality in children with sepsis: a systematic review and meta-analysis

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